A Comparison Between Community and Academic Practices in the USA in the Management of Chronic Hepatitis B Patients Receiving Entecavir: Results of the ENUMERATE Study

Hannah M. Lee, Joseph Ahn, W. Ray Kim, Joseph K. Lim, Mindie Nguyen, Calvin Q. Pan, Donghee Kim, Ajitha Mannalithara, Helen Te, Huy Trinh, Danny Chu, Tram Tran, Jocelyn Woog, Anna S. Lok

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Abstract

Background and Aims: The management of chronic hepatitis B patients is not well characterized in real-world practice. We compared baseline characteristics of CHB patients on entecavir, the frequency of on-treatment monitoring, and the effectiveness of ETV treatment between academic and community practices. Methods: Treatment-naïve CHB patients ≥18 years old, treated with ETV for ≥12 months from 2005 to 2013, in 26 community and academic practices throughout the USA were retrospectively evaluated. Results: Of 841 patients enrolled, 658 (65% male, 83% Asian, median age 47, 9% with cirrhosis) met inclusion criteria. Half of the patients (52%) were from community practices. A lower percentage of patients in community practices had cirrhosis or liver cancer (5 vs. 14%). Community practices more often treated patients with baseline ALT < 2 × ULN. Over a median follow-up of 4 years, community practices were more likely to discontinue ETV with less frequent laboratory monitoring compared to academic practices. The 5-year cumulative probability of ALT normalization was greater among patients treated in community practices (70 vs. 50%, p < 0.001), but the 5-year cumulative probability of undetectable HBV DNA was lower (45 vs. 70%, p < 0.001) than those treated in academic practices. Conclusion: Academic practices saw CHB patients with more advanced liver disease, more often followed AASLD guidelines, and monitored patients on ETV treatment more frequently than community practices. While patients in community practices were less likely to achieve undetectable HBV DNA and more likely to achieve ALT normalization, the rates of HBeAg loss and seroconversion as well as HBsAg loss were similar.

LanguageEnglish (US)
JournalDigestive diseases and sciences
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Chronic Hepatitis B
Fibrosis
entecavir
Hepatitis B e Antigens
DNA
Liver Neoplasms
Hepatitis B Surface Antigens
Liver Diseases
Therapeutics
Guidelines

Keywords

  • Antiviral therapy
  • Chronic HBV
  • HBeAg loss
  • HBsAg loss
  • Practice management

ASJC Scopus subject areas

  • Physiology
  • Gastroenterology

Cite this

A Comparison Between Community and Academic Practices in the USA in the Management of Chronic Hepatitis B Patients Receiving Entecavir : Results of the ENUMERATE Study. / Lee, Hannah M.; Ahn, Joseph; Kim, W. Ray; Lim, Joseph K.; Nguyen, Mindie; Pan, Calvin Q.; Kim, Donghee; Mannalithara, Ajitha; Te, Helen; Trinh, Huy; Chu, Danny; Tran, Tram; Woog, Jocelyn; Lok, Anna S.

In: Digestive diseases and sciences, 01.01.2018.

Research output: Contribution to journalArticle

Lee, Hannah M. ; Ahn, Joseph ; Kim, W. Ray ; Lim, Joseph K. ; Nguyen, Mindie ; Pan, Calvin Q. ; Kim, Donghee ; Mannalithara, Ajitha ; Te, Helen ; Trinh, Huy ; Chu, Danny ; Tran, Tram ; Woog, Jocelyn ; Lok, Anna S. / A Comparison Between Community and Academic Practices in the USA in the Management of Chronic Hepatitis B Patients Receiving Entecavir : Results of the ENUMERATE Study. In: Digestive diseases and sciences. 2018.
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title = "A Comparison Between Community and Academic Practices in the USA in the Management of Chronic Hepatitis B Patients Receiving Entecavir: Results of the ENUMERATE Study",
abstract = "Background and Aims: The management of chronic hepatitis B patients is not well characterized in real-world practice. We compared baseline characteristics of CHB patients on entecavir, the frequency of on-treatment monitoring, and the effectiveness of ETV treatment between academic and community practices. Methods: Treatment-na{\"i}ve CHB patients ≥18 years old, treated with ETV for ≥12 months from 2005 to 2013, in 26 community and academic practices throughout the USA were retrospectively evaluated. Results: Of 841 patients enrolled, 658 (65{\%} male, 83{\%} Asian, median age 47, 9{\%} with cirrhosis) met inclusion criteria. Half of the patients (52{\%}) were from community practices. A lower percentage of patients in community practices had cirrhosis or liver cancer (5 vs. 14{\%}). Community practices more often treated patients with baseline ALT < 2 × ULN. Over a median follow-up of 4 years, community practices were more likely to discontinue ETV with less frequent laboratory monitoring compared to academic practices. The 5-year cumulative probability of ALT normalization was greater among patients treated in community practices (70 vs. 50{\%}, p < 0.001), but the 5-year cumulative probability of undetectable HBV DNA was lower (45 vs. 70{\%}, p < 0.001) than those treated in academic practices. Conclusion: Academic practices saw CHB patients with more advanced liver disease, more often followed AASLD guidelines, and monitored patients on ETV treatment more frequently than community practices. While patients in community practices were less likely to achieve undetectable HBV DNA and more likely to achieve ALT normalization, the rates of HBeAg loss and seroconversion as well as HBsAg loss were similar.",
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author = "Lee, {Hannah M.} and Joseph Ahn and Kim, {W. Ray} and Lim, {Joseph K.} and Mindie Nguyen and Pan, {Calvin Q.} and Donghee Kim and Ajitha Mannalithara and Helen Te and Huy Trinh and Danny Chu and Tram Tran and Jocelyn Woog and Lok, {Anna S.}",
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AU - Kim, W. Ray

AU - Lim, Joseph K.

AU - Nguyen, Mindie

AU - Pan, Calvin Q.

AU - Kim, Donghee

AU - Mannalithara, Ajitha

AU - Te, Helen

AU - Trinh, Huy

AU - Chu, Danny

AU - Tran, Tram

AU - Woog, Jocelyn

AU - Lok, Anna S.

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AB - Background and Aims: The management of chronic hepatitis B patients is not well characterized in real-world practice. We compared baseline characteristics of CHB patients on entecavir, the frequency of on-treatment monitoring, and the effectiveness of ETV treatment between academic and community practices. Methods: Treatment-naïve CHB patients ≥18 years old, treated with ETV for ≥12 months from 2005 to 2013, in 26 community and academic practices throughout the USA were retrospectively evaluated. Results: Of 841 patients enrolled, 658 (65% male, 83% Asian, median age 47, 9% with cirrhosis) met inclusion criteria. Half of the patients (52%) were from community practices. A lower percentage of patients in community practices had cirrhosis or liver cancer (5 vs. 14%). Community practices more often treated patients with baseline ALT < 2 × ULN. Over a median follow-up of 4 years, community practices were more likely to discontinue ETV with less frequent laboratory monitoring compared to academic practices. The 5-year cumulative probability of ALT normalization was greater among patients treated in community practices (70 vs. 50%, p < 0.001), but the 5-year cumulative probability of undetectable HBV DNA was lower (45 vs. 70%, p < 0.001) than those treated in academic practices. Conclusion: Academic practices saw CHB patients with more advanced liver disease, more often followed AASLD guidelines, and monitored patients on ETV treatment more frequently than community practices. While patients in community practices were less likely to achieve undetectable HBV DNA and more likely to achieve ALT normalization, the rates of HBeAg loss and seroconversion as well as HBsAg loss were similar.

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